Quick Important PLAB CNS DDx]
◙ Chronic alcoholic + CAS (Confusion/ Ataxia/ Squint “Nystagmus, Ophthalmoplegia)
→ Wernicke’s encephalopathy (Vitamin B1 -Thiamine- deficiency).
◙ Chronic alcoholic ± CAS + Amnesia (memory loss) + Confabulation (Making up stories) → Korsakoff’s psychosis
◙ OLD man + GDU (Gait abnormality/ Dementia -behaviour changes-/ Urine urgency ± incontinence) = Wet, Wobbly, Wacky Grandpa
→ NPH (Normal Pressure Hydrocephalus).
◙ OLD + Making sexual or inappropriate comments (Disinhibition), Loss of social interest (disengagement), Acting inappropriately or impulsively, Personality and behaviour changes, Over-eating
→ Frontotemporal Dementia (Pick’s disease)
◙ Forgetful elderly (forget to look doors, forget birthdays, forget names of people and places), easily getting lost (Disorientation), unable to do simple tasks (e.g. cooking)
→ Alzheimer’s disease
◙ ACUTE onset (hours to days) of mood and behavioural changes + Hallucinations (mainly visual)
→ Delirium
◙ Elderly, UTI, developed confusion, fluctuating level of consciousness and disoriented to time and place.
→ Delirium
◙ Old age + Bradykinesia (slow movements) + Resting tremors + Rigidity + Postural instability ± Expressionless face.
→ Parkinson’s disease
◙ Parkinsonism (Parkinson disease features: Bradykinesia “slow movements” + Resting tremors + Rigidity + Postural instability “Ataxia”)
→ Parkinson’s Disease.
◙ Parkinsonism [+] Urinary incontinence, Erectile Dysfunction [±] Postural Hypotension “Frequent falls”
→ Shy-Drager Syndrome.
Mnemonic: “He is Shy as he wets his pants, has erectile dysfunction and Drags his feet because of his ataxia”.
◙ Parkinsonism [+] Dementia [+] Visual Hallucinations ± Delusions
→ Lewy Body Dementia.
◙ Tremors that are ABSENT at rest and DO NOT resolve with distraction + Worse when patient is tired or stressed
→ Essential Tremors (give Propranolol)
◙ Tremors absent at rest but resolve with distraction
→ Psychogenic tremors.
◙ Ataxia ▐ Intentional Tremors (e.g. when trying to touch his nose or catch something) ▐ Dysarthria ▐ Nystagmus. The affected part of the brain is → Cerebellum.
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